Preventive Medication Program offers employers more choice and members greater adherence opportunities

Non-adherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year.1 Cost is a common concern. For example, a survey of cardiovascular patients found that 1 in 8 reported cost as a reason for their nonadherence.2 More broadly, approximately one in four customers ration medications, leading to increased health risk, ER visits and hospitalizations.3 Lowering medication costs on maintenance medication in key drug classes can help to reduce clients’ total medical costs.

Cigna's Preventive Medication Program* can help. Clients who elect this program can choose to waive customer’s deductible and/or cost share on program medications, eliminating cost as a medication adherence issue. Among clients who adopted a preventive program, their members with diabetes had nearly 2% improvements in A1C reduction, 4% higher medication adherence, and reduced gaps in care.4

As of January, 1, 2022, Cigna pharmacy benefit plans will offer an updated strategy to help encourage long-term good health among members: a choice of preventive medication packages. These opt-in packages work along with our Patient Protection and Affordable Care Act (PPACA) no-cost-share preventive drug list. Clients can choose from one of four packages:

  • Preventive – This is our recommended package. It includes the therapeutic categories asthma, osteoporosis, depression, diabetes, heart disease and stroke, cholesterol, high blood pressure, and prenatal vitamins.
  • Preventive Plus – This package includes everything in the Preventive package, but also adds therapeutic Continuous Glucose Monitor supplies within the diabetic category. This package also folds in weight loss, smoking cessation and prescription vitamins if the client has added coverage of one or all of these therapeutic categories.
  • Diabetic Supplies and Continuous Glucose Monitor supplies (CGMs) – This package includes both generic and preferred brand diabetic supplies and therapeutic CGM supplies used to treat diabetes. The Patient Assurance Program is recommended with this package.
  • Diabetic Supplies Only – This package includes both generic and preferred brand supplies used to treat diabetes. It does NOT include CGM supplies. The Patient Assurance Program is required to elect this package.

In addition to choosing a preventive package, clients need to make decisions on including generics and/or brands, and either waiving their members’ deductible only or $0 cost share along with waiving deductible. Non-preferred brand cost share cannot be waived.

“Our client recommendation is the preventive package including generic and preferred brand medications, waiving deductible only,” said Cortney Zachman, product management senior advisor for Cigna Pharmacy Management. “We recommend including generic and preferred brand medications to ensure a choice of low-cost preferred brand options that don’t have generic equivalents. This recommendation provides a good balance of benefit to the member on these key drug classes to waive deductible, while still being affordable to the client.”

LEARN MORE

  1. Kleinsinger, Fred, MD. The Unmet Challenge of Medication Nonadherence. The Permanente Journal. U.S. National Library of Medication National Institutes of Health.nih.gov. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499?. 2018 July 5. Accessed March 17, 2021.
  2. Cost-Related Medication Nonadherence in Adults with Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. ahajournals.org. <https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.041974. 25 Nov. 2019. Accessed March 17, 2021.
  3. Caffrey, Mary. American Journal of Managed Care (AJMC), “Gathering Evidence on Insulin Rationing.” September 26, 2019.
  4. Cigna’s 2020 National Book of Business analysis on Preventive Medication Program.

*Preventive medication packages apply to a targeted list of drugs in prevention-focused drug classes. The term Preventive Medication does not include medications covered at 100% as required by PPACA, per preventive services guidelines (“PPACA Preventive Medications”), the terms of coverage for which are addressed separately.

Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, contact a Cigna representative.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Cigna Behavioral Health, Inc., Express Scripts, Inc., or their affiliates. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC).

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Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.

All Cigna products and service are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, (CHLIC), Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Evernorth, Accredo Health Group, Inc., Express Scripts, Inc., ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., Lynnfield Drug, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC). The Cigna name, logo, and other Cigna marks are trademarks of Cigna Intellectual Property, Inc. "Express Scripts" is a trademark of Express Scripts Strategic Development, Inc. This newsletter is not intended for residents of New Mexico.

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